Subcutaneous immunoglobulins in chronic lymphocytic leukemia with secondary antibody deficiency. A monocentric experience during Covid‐19 pandemics

Abstract

Secondary antibody deficiency (SAD) is a frequent manifestation of chronic lymphocytic leukemia (CLL) that increases the risk of infections. However, no formal guideline are available regarding the eligibility for prophylaxis or the delivery method, dosage, frequency of administration and duration of immunoglobulin replacement therapy (IgRT). The aim of this study was to assess the efficacy and safety of subcutaneous IgRT (SCIg) and its impact on quality of life (QoL) of CLL pts in the Covid‐19 era. Ten CLL pts with SAD were treated with subcutaneous IgRT (SCIg) at our institution between October 2019 and December 2020. Median age was 66 years and five patients had comorbidities. Seven patients were receiving therapy for CLL when treatment with SCIg was initiated. All pts received 10 g total dose hyaluronidase‐free SCIg independently from body weight. The IgG level and CD4/CD8, CD19 and CD16/56 lymphocytes subset were recorded at baseline and every 3 months. No patient experienced infectious events nor Covid‐19 mediated interstitial pneumonia while on SCIg therapy. All patients tolerated well the therapy and experienced an increase of IgG levels, which was then stable in time. We conclude that SCIg administration in CLL pts with SAD is efficacious and safe as infectious prophylaxis. This route of administration appears particularly advantageous in the Covid‐19 era, because of the self‐administration at home which results in improvement in the QoL and reduced treatment expenditures.

Current perspectives regarding SARS‐CoV‐2 vaccination in chronic lymphocytic leukemia

“… 54 In a small published series including 10 CLL patients, no patient experienced infectious events nor Covid‐19 mediated interstitial pneumonia while on subcutaneous Ig therapy. 54 …”

“…[13][14][15][16]23,[25][26][27][28][29][30] Because of the potential immunosuppres- Finally, despite controversial data, there is no contraindication to the use of complementary measures for infectious prophylaxis in CLL which may include subcutaneous Ig administration. 54 In a small MOLICA ET AL.…”

“…Finally, despite controversial data, there is no contraindication to the use of complementary measures for infectious prophylaxis in CLL which may include subcutaneous Ig administration 54 . In a small published series including 10 CLL patients, no patient experienced infectious events nor Covid‐19 mediated interstitial pneumonia while on subcutaneous Ig therapy 54 …”

“…published series including 10 CLL patients, no patient experienced infectious events nor Covid-19 mediated interstitial pneumonia while on subcutaneous Ig therapy. 54 Providing close recommendations on how the clinical management of CLL should be modified as a consequence of COVI19 pandemic is beyond the scope of the present review. We remand to specific position papers and guidelines already published, keeping in mind that clinical expertise and medical judgment are still of the utmost importance and should not be replaced.…”

Immunomodulation mediated by polyclonal IgG replacement in patients with chronic lymphocytic leukemia may be important in infection prevention

“…We read with interest the article by Idanna Innocenti and colleagues where a fixed dose of 10 g hyaluronidase-free SCIg (subcutaneous immunoglobulin IgG) was administered every 2 weeks for 1 year to 10 patients with chronic lymphocytic leukemia (CLL) and was highly effective in preventing infections. 1 It is generally accepted that frequency of infusions with hyaluronidase-free SCIg preparations are once weekly to maintain 'adequate' trough IgG, 2 microglobulin in blood suggesting IgRT may have anti-leukemic activity in CLL patients. 5 The authors discuss the possible mechanism is modulation via FcγRIIb, the IgG inhibitory receptor, that is predominantly on CLL cells; and low levels of this inhibitory receptor is independent of known prognostic markers but associated with a worse outcome.…”